艾滋病合并播散性马尔尼菲青霉菌病41例临床分析  

Clinical features of 41 cases of disseminated penicilliosis marneffei in patients with AIDS.

作　　者：莫让辉[1] 唐小平[1] 蔡卫平[1] 陈谐捷[1] 陈万山[1] 

机构地区：[1]广州市第八人民医院

出　　处：《中国实用内科杂志：临床前沿版》2006年第12期1953-1955,共3页

基　　金：广州市重大科技攻关项目(2001-Z-023-01);广东省科技攻关项目(2003C33904)

摘　　要：目的总结艾滋病合并播散性马尔尼菲青霉菌病的临床特点及治疗经验。方法对2002年11月至2005年6月广州市第八人民医院住院的41例艾滋病合并播散性马尔尼菲青霉菌病患者的临床及实验室检查资料进行分析。结果临床表现发热41例(100%),消瘦41例(100%),贫血38例(92·7%),皮疹30例(73·2%),咳嗽25例(60·9%),淋巴结肿大22例(53·7%);41例患者中,39例外周血CD4+<50×106/L,1例CD4+105×106/L,1例CD4+86×106/L;所有病例血液中均培养出马尔尼菲青霉菌,其中24例骨髓、9例支气管肺泡灌洗液培养出马尔尼菲青霉菌,5例纤支镜活检组织、5例死亡病例多个病理组织找到马尔尼菲青霉菌;使用氟康唑、伊曲康唑或二性霉素B等治疗,治愈30例,6例自动出院,5例死亡,以二性霉素B疗效最好,氟康唑疗效差。结论艾滋病合并马尔尼菲青霉菌病以发热、消瘦、贫血、皮疹、咳嗽、淋巴结肿大等为主要表现,多发生于CD4+计数小于50×106/L的患者,二性霉素B可作为治疗艾滋病合并播散性马尔尼菲青霉菌病的首选药物。Objective To explore the clinical and laboratory features of disseminated Penicillium Mameffei （PSM） infection in patients with AIDS. Methods The clinical and laboratory data of 41 cases of disseminated PSM associated with AIDS were retrospectively analyzed. Results The most presented clinical symptoms and signs in descending order were fever （41/41, 100%）, symptosis （41/41, 100%）, anemia （38/41, 92.7%）, skin rash （30/41, 73.2%）, cough （25/41, 60. 9%） and lymphadenopathy （22/41, 53.7% ）. Most patients （39/41） had CD4^＋ count in periphery blood below 50/μL. All patients were found to be positive for PSM in blood cultures and 24 were positive in bone marrow cultures and 9 were positive in bronchoalveolar lavage fluid cultures. PSM infections were also confirmed histologically from the bronchial fiber endoscope biopsies in 5 cases and from the liver, lung and kidney tissues in another 5 dead cases by pathological examination. Patients were treated with Fluconazole, Itraconazole or Amphotericin B （AMB） with 30 cured, 6 discontinued due to the their own reasons and 5 died. AMB was most effective among these treatments. Conclusion Patients with AIDS- complicated disseminated Penicillium Marneffei infection mainly manifested with fever, symptosis, anemia, skin rash, cough and lymphadenpathy. PSM infection was mostly seen in AIDS patients with CD4^＋ count less than 50/μL. Amphotericin B can be used as the first choice for the treatments of this infection.

关 键 词：获得性免疫缺陷综合征 马尔尼菲青霉菌 

分 类 号：R5[医药卫生—内科学]